Barriers to timely treatment-seeking in patients with acute myocardial infarction in Malaysia: a qualitative study

Abstract

BackgroundPersisting delay in seeking treatment among Acute Myocardial Infarction (AMI) patients was reported in Malaysia despite intensified efforts in educating the public on symptoms of AMI and the importance of seeking prompt treatment. Studies outside Malaysia have shown that patients’ personal thoughts during symptom onset could contribute to the delay. The purpose of this study is to explore the barriers of AMI patients prior to the decision of seeking treatment in Malaysia.MethodsA qualitative descriptive research approach was chosen. Individual in-depth interviews were conducted among 18 patients with AMI. Data were analysed using thematic analysis. Recordings were transcribed and coded, codes were subsequently organized into categories. The stages of coding and identifying categories were repeated before themes were identified.ResultsThree meaningful themes with nine sub-themes that may have influenced the delayed decision to seek treatment were identified. Some themes identified were culturally bound.ConclusionsThe findings of this study give insights on barriers prior to the decision of seeking treatment when patients were experiencing AMI. Findings indicates that interventions targeted at increasing knowledge about AMI symptoms and correct actions using an informative approach at the current practice may not be adequate to reduce patient delay. The findings of this study could provide basis for the development of interventions that are culturally relevant to the Malaysians setting to promote behavioural change in the population and reduce pre-hospital delay.

Treatment seeking behaviours and associated factors among patients experiencing acute coronary syndrome using health belief model in Addis Ababa, Ethiopia

“…The other health belief model construct which is inversely associated with help seeking behavior in response to ACS symptoms is perceived barrier. In our study, participants who had difficulty to overcoming barriers of help seeking decisions such as (cost, transporation, time and lack of trust on the treamnet ) had inadequate treamnet seeking behaviour in response to ACS symptoms.. Other findings also support that higher perceived barriers are predictor of delayed treatment seeking behaviour ( 28 , 29 ). In addition, participants who had depressive symptoms were also more likely to have inadequate treatment seeking for an AMI( 48 , 49 ).…”

“…In the present study, the time from ACS symptom onset to treatment was 12 hours or longer and is supported by Bogale and colleagues( 24 ), from Ethiopia and in other LMICs( 26 , 27 ). The association between delayed treatment in ACS in LMICs is well established ( 28 – 31 ). Lack of awareness of symptoms as cardiac in origin particularly among those with lower sociodemographic, educational status and female gender were the factors that contribute to increase in delay from symptom onset to treatment in LMICs( 32 , 33 ).…”

Barriers and facilitators to implementing coronary care networks in South Africa: a qualitative study

“…This could be related to the fact that patients misperceive their symptoms as not being serious, attributing it to other more benign conditions, "this could maybe just be heartburn (P1, ECP)." Studies from many different settings, [27][28][29][30] including South Africa, 6 corroborate the notion that misinterpretation of symptoms and attempts at self-medication are the main reasons for delays in seeking healthcare after symptom onset. A further reason for this delay seemed to be related to access to transport, "they can't get there, either taxis are expensive or taxis don't run after hours (P9, EP)," and "access to a vehicle, is almost unheard of (P9, EP)."…”

Patient pathways for cardiovascular diseases in Malaysia and the Philippines: a systematic review

“…One qualitative study examined delays in seeking care by patients with acute myocardial infarction (AMI) in Malaysia 39 . On average, patients took 204 minutes to decide to seek care at hospital after experiencing AMI symptoms.…”